Obamacare and Seniors

If you’re over the age of 65, your health insurance options under the Affordable Care Act depend on whether or not you’re covered by Medicare or another insurance plan. To find out what, if anything, you need to do, find the situation below that applies to you.

You have Medicare. If you’re already enrolled in Medicare, you’re considered covered under the ACA, and you don’t have to do anything. In fact, it’s illegal for someone who knows you have Medicare to try to sell you a plan through a health care marketplace.

The Affordable Care Act enhances your existing Medicare coverage in a couple of important ways:

If you fall into the prescription drug “donut hole,” there are new discounts to help you save money until the hole closes completely in 2020.

For more information on Medicare coverage, go to Medicare.gov. To learn about Medicare Advantage plans -- which include traditional Medicare benefits, prescription drug coverage, and more -- see Medicare Advantage By Zip Code.

You’re over 65 but not eligible for Medicare. You are welcome to purchase a health plan from Connect for Health Colorado, the health insurance marketplace for Colorado. If you meet the qualifications based on income and family size, you are eligible for cost-saving subsidies, too.

You have retiree health benefits. If you have a health plan from a previous employer, you’re considered covered under the Affordable Care Act. You don’t have to do anything -- and you don’t have to worry about the penalty faced by the uninsured. That said, you are welcome to shop for a new, individual health plan at Connect for Health Colorado. However, if your retirement coverage is considered affordable and meets certain minimum standards, or if you are eligible for Medicare but have chosen not to enroll, you won’t qualify for Obamacare’s cost-saving subsidies.

You don’t have any health coverage. Older adults who aren’t enrolled in Medicare and have no other health coverage may owe a tax penalty. If you are currently uninsured, you can enroll in a plan at Connect for Health Colorado. Keep in mind, however, that if you are eligible for Medicare but choose to enroll in a marketplace plan instead, you will not qualify for the cost-saving subsidies offered by the Affordable Care Act.

What do Obamacare health care plans cover?

All health plans purchased through the Connect for Health Colorado, the health insurance marketplace for Colorado, must include the following benefits. These are known under Obamacare as “essential health benefits”:

Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)

What if I already have health insurance?

If you used the marketplace to purchase a plan last year. Most people who purchased their 2016 insurance plan from an online marketplace will be able to automatically renew their coverage for 2017. While automatic renewal sounds convenient, it has serious downsides:

If your insurer decides to cancel your current plan, you could be switched to another plan without warning. The new plan may cost you more or change your eligibility for financial assistance.

Automatic re-enrollment could mean you aren't getting the right subsidy package. That could leave you facing higher monthly premiums now or -- if you take more assistance than you're eligible for -- a big tax bill later.

You may miss out on a better deal or better coverage if you don't compare all available plans to your current plan.

While allowing yourself to be automatically re-enrolled is better than going without insurance, it's best to take advantage of open enrollment and research your options. Shop around and evaluate new plans and costs. Even if you decide to stay with the plan you have, you can use open enrollment to confirm your personal information and ensure you're getting the right amount of financial aid.

If you purchased an individual or family insurance plan outside the online marketplace. As long as the plan meets Obamacare's coverage requirements, you can keep it. Or, you may use Connect for Health Colorado to compare plans and replace it. If you keep your current plan, you won't be eligible for the cost-saving subsidies available for plans purchased through the exchange.

Be sure to check with your current insurance provider before canceling a health insurance policy; you may have to wait until the end of your current policy year to make a change.

If you have insurance through an employer. As long as you're happy with your plan, you can keep it. You're considered covered under Obamacare. On the other hand, if you're not satisfied with the coverage you have, you may be able to switch to an individual plan through Connect for Health Colorado.

Keep in mind that if you buy a plan through the exchange:

Your employer will not have to pay a portion of your monthly premiums.

You may not qualify for cost-saving subsidies, even if your income falls within the eligible range. If your employer offers coverage that is considered affordable and sufficient under the law, you won't qualify to save on premiums or out-of-pocket costs for plans purchased through Connect for Health Colorado.

What is the health insurance marketplace?

The health insurance marketplace (sometimes called an "exchange") is where to go to get health insurance under the Affordable Care Act. The marketplace for Colorado is Connect for Health Colorado. You can use the marketplace to compare plans, learn whether you qualify for cost-saving subsidies, and sign up for the plan that works best for you.

Where can I get in-person help with my application?

In Colorado, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a navigator (often called a "Health Coverage Guide" or "Certified Application Counselor" in Colorado) or from a health insurance agent or broker.

Navigators can explain your options, answer your questions, and help you apply for the plan you choose -- but they can't recommend a specific plan for you.

Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government-trained navigators and counselors, they are allowed to suggest the best plan for you.

Find a navigator. To find a navigator, go the In-Person Assistance page at Connect for Health Colorado.

Talk to a licensed broker. To directly connect with a Colorado insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

What does "open enrollment" mean?

"Open enrollment" is the period of time, once a year, when you can choose or change your insurance provider or what kind of plan options you want -- for example, monthly premium and annual deductible amounts -- for the upcoming calendar year. For the dates of the next open enrollment period, see What Colorado Residents Need to Know About Obamacare.

Choose carefully, because after you make your choices, you must usually live with them until the next open enrollment period.

"Special enrollment" is an exception to the usual enrollment rules. If you qualify for special enrollment, you can sign up during a time period outside of the open enrollment period. The circumstances under which you may qualify for special enrollment include:

What if I live in more than one state?

You should purchase a plan from the marketplace in the state you consider your primary residence -- where you vote, pay taxes, and so on. But snowbirds need to be sure they choose an appropriate “multistate” plan.

Some multistate plans may be restricted to a certain region – for example, a metropolitan area that straddles state boundaries. Others will be more appropriate for someone who migrates longer distances, spending, say, summers in Alaska and winters in Arizona.

Ask the insurance provider for details, and don’t sign up for a plan until you’re sure it will cover you where and when you need it.

What if I travel frequently?

Traveling shouldn't present any problem under a marketplace insurance plan. Simply sign up for a plan in the state of your primary residence. The plan will cover you in case of emergencies that happen out of state.

Learn More

For more information about Obamacare in any state, including a link to the state’s health insurance exchange, choose the state from this list.

Information & Documents to Have on Hand

Here's a checklist of information to gather before you apply for health coverage at Connect for Health Colorado.

Social Security numbers for you and other members of your household who will be covered by your insurance plan

Policy numbers for any current health insurance plans

Documents to help you calculate your annual income. Include all sources, such as employment, pensions, alimony, rental property, or other income. If you have a job, gather together pay stubs or W-2 forms. If you’re self-employed, have last year’s tax return handy, as well other records that can help you estimate your yearly income.

If you or anyone in your household is eligible for job-based health insurance, a completed Employer Coverage Tool for each available plan

A good idea of your budget for health insurance, so you know how much you can afford to spend each month. This will help you choose the best plan from among those offered to you.

HealthCare.gov offers an Application Checklist you can print to help you keep track of everything you'll need to sign up.

Finally, keep a list of any questions you want answered before you sign up for a health insurance plan. To get answers to your questions, or for information on signing up for a plan, see How Do I Sign Up for Obamacare in Colorado?

About This Website

Press Release: New Website Provides Local Obamacare Information

September 23, 2013

A new website, ObamacareByZipCode.com, gives people the answers they need about the Affordable Care Act (Obamacare). In plain English, it guides consumers to reliable, local information about their new health insurance options.

When users choose their state or enter their zip code, they will quickly find:

whether or not they’re required to get health insurance

what the available plans cover

how much coverage will cost, and

how to sign up in each state.

For consumers concerned about cost, the site shows how to determine whether they qualify for subsidies. It also explains the new rules about expanded Medicaid eligibility.

The new site was created by Albin Renauer, founder of LegalConsumer.com, and is coauthored by Renauer and legal editor and writer Shae Irving. LegalConsumer, which until now has concentrated on consumer bankruptcy, began in 2005, when Congress overhauled federal bankruptcy laws.

“When politicians tried to make it harder to file bankruptcy, I vowed to make it easier. When I read about politicians making it hard to get information about Obamacare, it got my blood boiling -- and I realized I could help folks find that information the same way I do with bankruptcy.”

Some states, says Renauer, are hiding the ball when it comes to the new options for healthcare coverage under Obamacare. Missouri, for example, has not created an insurance marketplace (exchange), forbids state officials from cooperating with the federal government, and provides no information. “It is being run like a covert operation, with no marketing or detailed information about its products or their prices,” wrote the New York Times. (Missouri Citizens Face Obstacles to Coverage, Aug. 2, 2013.)

On ObamacareByZipCode.com, all consumers need to do, says Renauer, is start with a zip code. The site will guide them to all the official local resources they need to make sure they get the maximum benefits under the law.

Another reason for expanding a bankruptcy website to cover health care reform? It’s obvious to Renauer: “Huge medical bills are a major reason that people are forced into bankruptcy.”

About LegalConsumer.com

LegalConsumer.com has helped more than a million consumers navigate the bankruptcy process by providing a free online “means test calculator,” which shows people whether or not they’re eligible to file for bankruptcy.

After receiving his J.D. from the University of Michigan Law School in 1985, Albin Renauer worked for various public-interest law firms in the Bay Area and as a staff attorney for Chief Justice Rose Bird of the California Supreme Court. He spent 17 years as an editor at leading do-it-yourself legal publisher Nolo, where he helped create numerous books and software programs, including the bestselling Quicken WillMaker. He also edited Law on the Net, the first online directory of legal resources, and was the architect of Nolo's Webby Award winning website.

FOLLOW US

Obamacare Website content by Albin Renauer and Shae Irving
ObamacareByZIpCode.com and ObamaCareIsNotDead.com
are domains used by LegalConsumer.com
Users of this site agree to the Terms of Service and Privacy Notice.